Renewal Questionnaire                                                                    

As a valuable partner of CIBC’s, it is vital we have the most accurate and up to date information in our records as it relates to your groups employee benefit offerings. As we prepare for your annual renewal process, please complete the following questionnaire. This will help ensure we are providing you with the most accurate information during our annual analysis of your employee benefits.

*To calculate ATNE, use the prior calendar year. Take the total employee count (full time, part time, etc) for each month, add those numbers together and divide by 12.
Please indicate if amounts are based on a % of a premium or a fixed $ amount.
If applicable
If applicable
If applicable
If applicable
If applicable
This information is used by CIBC to help Applicable Large Employers (50+, as defined by the Affordable Care Act) calculate if their benefits meet affordability thresholds.
Does this apply to all benefits you offer?
Is this the same for all benefits you offer
Is this the same for all benefits offered?
If you have any questions on the information requested in this document, please contact your CIBC Account Manager or call Amanda Mast at 217-840-1460 or email amast@cibcinc.com